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Friday, September 19, 2014

C1 nerve root block on Monday!

Yesterday I had my appointment with Dr. Chong, a vascular radiologist at Mayo Clinic. My neurologist, Dr. Dodick, had referred me to him to discuss a C1 nerve root block. In short, the visit went really well and we left with a plan of action that Craig and I are both feeling good about.

As he reviewed my radiology reports and we started discussing my "story", Dr. Chong reiterated to us that he isn't a headache specialist, or a even a pain specialist for that matter. He specializes in neurointervention. Basically, he puts needles in places that are hard to get to. And he's good at it.

As I've explained before, C1 blocks aren't common and that's because it's an area of prime real estate. The needle's target is a 2-3 mm space and Dr. Chong will perform the procedure under CT guidance (whereas my previous blocks/ablations have been under fluoroscopy). I mentioned in my last post that we needed to find out how much experience Dr. Chong has had with C1 nerve root blocks. He's only done a handful (which is a handful more than every other doctor) but his experience and expertise IS in using guided procedures to treat conditions like brain aneurysms, vascular malformations of the brain, etc. The way he explained it was that his experience/skill in the "how" of what he does is actually more important than there "where".

The procedure, which I'm scheduled to have THIS MONDAY (!!!) could potentially be both diagnostic and therapeutic. It will contain a short-acting anasthetic (lidacaine) and an anti-inflammatory (celestone). We'll start with just the left side this Monday, as he didn't want to do both sides in one day in case I didn't respond well.

The potential scenarios are as follows...

1. I start feeling pain relief in the first 24-48 hours, the pain cycle is finally broken, and my headache is gone forever. This scenario would kick ass, but what's more likely is...

2. I start feeling relief in the first 24-48 hours and my relief is temporary. The next step would then be for me to see Dr. Barry Birch, a spine surgeon at Mayo who would likely perform a permanent risotomy (where the nerve is actually cut). When we asked whether they'd consider a pulsed radiofrequency ablation like I had at C2-C5, Dr. Chong explained that although they're less invasive, RFs aren't quite as precise (i.e. safe).

3. I don't feel relief. Then we'll try the right side the next week.

4. I don't feel relief from either side. Then I'll be done with Dr. Chong and will loop back with Dr. Dodick to figure out next steps. (Dr. Chong is like a contractor here...basically being hired to perform a very specific task).

Lastly, Dr. Chong was NOT concerned at the basilar invagination from my MRI. He assured us that he actually sees this quite a bit and it doesn't worry him with me, simply because I have enough fluid surrounding my spinal cord in that area that appears to be "kinked". So that's great news.

I'll plan to update after Monday's procedure... Thanks for all the positive thoughts sent my way. They're felt and appreciated : )

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